1. Which of the following structures is not connected to the hyoid bone by a muscle?
A)
styloid process of the temporal bone
B)
mastoid process of the temporal bone
C)
scapula
D)
manubrium
E)
body of mandible
Ans:
B
2. During radical neck surgery for cancer, the surgeon inadvertently cut the cervical branch
of the facial nerve. Which of the following signs would not be observed in the patient?
A)
sagging of the skin of the neck on the ipsilateral side
B)
reduced ability to convey some facial expressions
C)
reduced force in ability to open mandible against resistance
D)
reduced sensation on the skin of the neck of the ipsilateral side
E)
reduced skin tension overlying the superior aspects of the deltoid and pectoralis
major muscles
Ans:
D
3. In the following transverse CT scan through the neck, the arrow points to the:
A)
B)
C)
D)
E)
Ans:
esophagus.
trachea.
thyroid gland.
body of the 6th cervical vertebrae.
spinal cord.
A
4. In the following transverse CT scan through the neck, which is at a more inferior level
than the scan shown in the previous question, the arrow points to the:
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A)
B)
C)
D)
E)
Ans:
lobe of thyroid gland.
sternocleidomastoid.
sternohyoid.
longus colli.
internal jugular vein.
E
5. Which of the following is not correct pertaining to the retropharyngeal space?
It is between the prevertebral fascia and the buccopharyngeal fascia.
It is closed inferiorly by the pretracheal fascia.
It is closed laterally by the carotid sheath.
It facilitates movement of the pharynx, larynx, and esophagus relative to the
vertebral column during swallowing.
E)
It is subdivided by the alar fascia.
Ans:
B
A)
B)
C)
D)
6. In a newborn infant, torticollis resulting from a tissue tumor most likely involves which
of the following muscles?
A)
sternocleidomastoid
B)
trapezius
C)
scalenus anterior
D)
semispinalis cervicis
E)
levator scapulae
Ans:
A
7. Which of the following is not true of either the transverse cervical or suprascapular
arteries?
A)
typically arises from the thyrocervical trunk
B)
typically passes anterior to scalenus anterior
C)
supplies the cords of the brachial plexus
D)
occasionally arises from the third part of the subclavian artery
E)
provides blood to the deltoid
Ans:
E
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8. Which structure is most likely to be penetrated during a subclavian vein puncture if the
needle is inserted too far posteriorly?
A)
internal jugular vein
B)
common carotid artery
C)
subclavian artery
D)
lateral cord of brachial plexus
E)
thoracic duct
Ans:
C
9. Which of the following is incorrect pertaining to the external jugular vein?
It is the best vein to use for right cardiac catheterization.
It typically is a tributary of the subclavian vein.
It crosses the sternocleidomastoid muscle superficially.
Abnormal prominence may indicate heart failure.
If slashed open in the neck, its lumen may be held open by the investing layer of
deep cervical fascia resulting in an air embolus.
Ans:
A
A)
B)
C)
D)
E)
10. In the following illustration, what is the name of the vessel indicated by the arrow?
A)
B)
C)
D)
E)
Ans:
inferior parathyroid artery
inferior thyroid artery
thyroid ima artery
accessory thyroid artery
recurrent thyroid artery
C
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11. Upon examination of a patient with a knife wound to the right side of her neck, you
observe that the patient has weakness turning her head to the left against resistance and
has a drooping right shoulder. Your diagnosis is injury to the:
A)
right sternocleidomastoid muscle.
B)
left levator scapulae muscle.
C)
right spinal accessory nerve.
D)
left dorsal scapular nerve.
E)
right dorsal scapular nerve.
Ans:
C
12. Which of the following is incorrect pertaining to the cervical plexus?
A)
It innervates the omohyoid, sternohyoid and sternothyroid.
B)
It innervates a muscle that turns the head.
C)
It provides sensory innervation to some of the face.
D)
It provides sensory innervation to some of the scalp.
E)
It provides sensory innervation to some of the shoulder.
Ans:
B
13. The phrenic nerve:
A)
provides the sole motor innervation to the diaphragm.
B)
is derived from the brachial plexus.
C)
contains sympathetic fibers derived from the inferior cervical ganglion.
D)
enters the chest by passing anterior to the subclavian vein.
E)
forms posterior to the anterior scalene muscle.
Ans:
A
14. Which of the following is incorrect pertaining to the infrahyoid muscles?
A)
They depress the hyoid bone during swallowing and speaking.
B)
One of them attaches to the scapula.
C)
One of them passes posterior to the thyroid gland.
D)
One of them has an attachment to the clavicle.
E)
All but one are innervated by the ansa cervicalis.
Ans:
C
15. Which one of the following arteries is not a branch of the external carotid?
A)
middle meningeal
B)
occipital
C)
facial
D)
lingual
E)
maxillary
Ans:
A
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16. Which of the following is not correct pertaining to a male patient scheduled for internal
carotid endarterectomy?
A)
He has atherosclerotic thickening of the intima of his internal carotid artery.
B)
He is at risk for a transient ischemic attack.
C)
A Doppler color flow study could have been used to detect his condition.
D)
One of the nerves typically at risk during this procedure is the recurrent laryngeal
nerve.
E)
Nerve damage during the procedure can result in loss of sensory innervation of
the larynx superior to the vocal folds.
Ans:
D
17. What is the name of the structure indicated by the arrow in the following illustration?
A)
B)
C)
D)
E)
Ans:
central lobe of thyroid gland
pyramidal lobe of thyroid gland
isthmus of thyroid gland
upper parathyroid gland
thyroid fistula
B
18. In the following median MRI though the lower head and neck, the arrow points to the:
Page 5
A)
B)
C)
D)
E)
Ans:
vestibule.
piriform recess.
vallecula.
nasal cavity.
choanae.
C
19. In a patient with carotid sinus hypersensitivity, which of the following actions should
not be performed by or on a patient?
A)
cervical plexus nerve block
B)
carotid endarterectomy
C)
taking a carotid pulse
D)
Valsalva maneuver
E)
swallowing reflex maneuver
Ans:
C
20. Which of the following is incorrect pertaining to the internal jugular vein?
A)
It receives blood from the inferior petrosal sinus.
B)
It is in the carotid sheath.
C)
It is accompanied in the upper neck by the great auricular nerve.
D)
It has pulsations that are observable in some cases of mitral valve disease.
E)
Typically, the right vein is used for catheterization.
Ans:
C
21. The longus colli and capitis muscles:
A)
extend the neck.
B)
are located posterior to the retropharyngeal space.
C)
are innervated by the dorsal rami of the upper cervical nerves.
D)
elevate the ribs.
E)
are covered anteriorly by the investing layer of deep cervical fascia.
Ans:
B
22. “Venous angle” refers to:
the junction of the two brachiocephalic veins to form the superior vena cava.
the junction of the internal jugular and subclavian veins.
the angle that the internal jugular vein makes as it crosses the sternocleidomastoid
muscle.
D)
the angle that the axillary vein makes as it crosses the clavicle.
E)
the angle that the anterior jugular vein makes with the midline of the neck.
Ans:
B
A)
B)
C)
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23. In the following coronal MRI through the lower head and neck, the arrow points to the:
A)
B)
C)
D)
E)
Ans:
vestibule.
piriform recess.
trachea.
vallecula.
retropharyngeal space.
B
24. The cervical sympathetic trunks:
A)
are in the carotid sheaths.
B)
connect to cervical spinal nerves by gray and white communicating rami.
C)
emit cardiopulmonary splanchnic nerves.
D)
emit cranial splanchnic nerves.
E)
typically have ganglia associated with each spinal level.
Ans:
C
25. Which one of the following signs is not consistent with Horner syndrome?
A)
drooping of the upper eyelid (ptosis)
B)
sinking of the eye (enophthalmos)
C)
contraction of the pupil (miosis)
D)
profuse sweating while eating
E)
vasodilation in the skin of the forehead
Ans:
D
26. Which of the following is incorrect pertaining to the thyroid gland?
Its secretions are controlled by sympathetic fibers derived primarily from the
inferior cervical ganglion.
B)
Its isthmus usually lies anterior to the 2nd and 3rd tracheal rings.
C)
It is typically drained by three pairs of veins.
D)
It receives blood via branches of both the subclavian and external carotid arteries.
E)
It may become abnormally enlarged, resulting in a goiter.
A)
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Ans:
A
27. While assisting a surgeon excising a malignant thyroid gland, the surgeon asks you why
she is ligating the inferior thyroid artery so far from the gland. You correctly respond
by stating that she is doing this to avoid injuring which of the following nerves?
A)
sympathetic trunk
B)
superior cardiac nerve
C)
phrenic nerve
D)
external laryngeal nerve
E)
recurrent laryngeal nerve
Ans:
E
28. During a surgical procedure to excise a malignant thyroid gland, the surgeon asks you
why she is not removing the posterior part of the patient's thyroid gland. Your correct
response is:
A)
so that the patient does not develop tetany.
B)
to avoid damage to the trachea .
C)
because it is only the posterior part of the gland that produces calcitonin.
D)
to avoid damage to the inferior laryngeal nerve.
E)
to avoid excessive bleeding.
Ans:
A
29. Which of the following is incorrect for the cricoid cartilage?
A)
It comprises the only complete cartilaginous ring of the airway.
B)
It articulates with the arytenoid cartilages.
C)
It is an attachment of the vocal ligaments.
D)
It is connected via a ligament to the thyroid cartilage.
E)
It is connected via a joint to the thyroid cartilage.
Ans:
C
30. Which of the following is incorrect pertaining to aspiration of a foreign body?
Contact with the mucosa of the vestibule of the larynx will induce laryngeal
musculature spasm.
B)
Contact with the mucosa of the vestibule of the larynx will cause violent
coughing.
C)
A Valsalva maneuver may be used to dislodge the foreign body.
D)
In extreme cases a needle cricothyrotomy permits rapid entry of air into the
trachea.
E)
Death will occur in approximately five minutes if the airway is fully obstructed.
Ans:
C
A)
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31. Which of the following associations pertaining to the muscles of the larynx is incorrect?
A)
posterior cricoarytenoid muscles—widen rima glottidis
B)
cricothyroid muscles—raise pitch of voice
C)
thyroarytenoid muscles—lower pitch of voice
D)
lateral cricoarytenoid—adduct vocal folds
E)
transverse and oblique arytenoid muscles—relax upon swallowing
Ans:
E
32. In the last part of the nineteenth century, a German/British laryngologist named Felix
Semon formulated a medical law that now bears his name, Semon's Law. The law states
that in any injury of a certain nerve, the abductors of the vocal cord become affected
sooner than the adductors. The nerve that Semon's Law refers to is the:
A)
superior laryngeal.
B)
recurrent laryngeal.
C)
internal laryngeal.
D)
external laryngeal.
E)
glossopharyngeal.
Ans:
B
33. Which of the following is incorrect pertaining to a tracheostomy?
It is safer to do in infants than adults because the esophagus is more offset and
thereby less likely to be injured.
B)
The isthmus of the thyroid gland is typically divided or retracted.
C)
Care must be taken to avoid transecting an artery that is sometimes present and
runs immediately superficial to the trachea.
D)
Care must be taken to avoid transecting the inferior thyroid veins.
E)
It is typically performed through a portion of the first four tracheal segments.
Ans:
A
A)
34. As the bolus of food enters the oropharynx during swallowing, all of the following
actions occur except:
A)
the infrahyoid muscles act to depress the larynx.
B)
the oropharynx is closed off from the nasopharynx.
C)
the oropharynx is shortened.
D)
the soft palate is elevated.
E)
the constrictor muscles contract.
Ans:
A
35. While assisting in the emergency removal of a small toy from a young child's piriform
recess, the attending physician asks you to tell him what nerve might be injured if the
mucosa lining the recess is penetrated. You reply the:
A)
vagus nerve.
Page 9
B)
C)
D)
E)
Ans:
glossopharyngeal nerve.
lingual nerve.
internal laryngeal nerve.
spinal accessory nerve.
D
36. Which of the following statements pertaining to the pharynx is incorrect?
A)
The internal laryngeal nerve passes through the gap between the middle and
inferior constrictors.
B)
The maxillary and vagus nerves predominantly supply the pharynx with sensory
innervation.
C)
The inferior constrictor muscle receives some motor innervation from the external
laryngeal nerve.
D)
The palatine tonsil receives some blood via a branch of the facial artery.
E)
The pharyngeal “tonsillar ring” refers to an incomplete ring of lymphoid tissue
within the pharynx.
Ans:
B
37. Which of the following is incorrect (or least likely) pertaining to adenoiditis?
A)
It refers to inflammation of the pharyngeal tonsil.
B)
It may involve obstruction of the choanae.
C)
It may be associated with impairment in hearing.
D)
It may be associated with an orbital infection.
E)
It may be associated with otitis media.
Ans:
D
38. Which of the following statements pertaining to the cervical esophagus is incorrect?
A)
The recurrent laryngeal nerve supplies somatic innervation.
B)
It begins at the inferior border of the cricoid cartilage.
C)
Its associated veins drain into the inferior thyroid veins.
D)
Perforations typically heal completely, without surgery and without serious
complications.
E)
Dysphagia is the most common symptom associated with cancerous infiltration.
Ans:
D
39. The main group of deep cervical lymph nodes is located:
A)
adjacent to the trachea.
B)
along the external jugular vein.
C)
along the internal jugular vein.
D)
along the subclavian vein.
E)
in the retropharyngeal space.
Ans:
C
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40. The woman in the following photograph is suffering from:
A)
B)
C)
D)
E)
Ans:
excessive contraction of platysma.
goiter.
spasmodic torticollis.
lesion of the left facial nerve.
overactivity in muscles innervated by the right ansa cervicalis.
C
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